Union Memorial (Regional)

About

Union Memorial (MedStar Health) is a regional anesthesia elective available to CA-3s who have completed their initial regional rotation downtown. You will work directly with attendings (some remote Hopkins grads) and interact with experienced CRNAs.

Getting Started

Site coordinators

• Joshua Dishon (Chair of Anesthesiology Department at Union Memorial)
• Nicole Allen (Administrator)

The Experience

• 2 week call-free rotation at major orthopedic surgery center
• Expect to get significant experience with both upper and lower extremity blocks. Arguably, the rotation rounds out blocks we do not perform as often at other sites. Most commonly:
  • Total Shoulders: Interscalene (single-shot)
  • General Hand: Infraclavicular, often with catheter placement (preferred over supraclavicular per general institutional preference)
  • Total Knees: Post-op adductor catheters
  • Miscellaneous Knee Procedures: Adductor/IPACK
  • AKA/BKA: Fem/Sciatic catheters
  • Other (less frequent): PECS catheters, TAP catheters

First Day

• Union Memorial Hospital is located at the Hopkins Homewood campus (201 E University Parkway)
• You'll park in Garage A first day and park in Garage B once you have your parking associated with your employee badge.
  • If there is a parking attendant outside the garage that asks if you are a patient, just say yes otherwise they won't let you into the garage
• You'll confirm your Powerchart access, get scrubs/meal card, and meet with Dr. Dishon (Josh) who will take you around, expect to jump into a block as soon as opportunity arises
• There are three floors of ORs: Ground floor (hand +/- shoulders), 3rd floor (newer, knee/hip +/- shoulders), 4th floor (cardiothoracic and vascular [AKA's, BKA's, AVF's])
• Codes: Block cart (0531), 3rd floor staff lounge (2019)
  

  Union Memorial Hospital Campus - Parking located off Calvert Street (turn onto 34th street).

Contact Info (please do not distribute)

• Nicole Mitchell (Admin Assistant) 410-554-6559
• Josh Dishon MD 443-904-2026
• Mark Jensen MD 585-953-9797
• Kerry Blaha MD 410-258-5758
• Tandi Mohammed MD 443-4447-5946
• Jane Radov MD 443-691-3000
• Rahul Guha MD 734-223-3061
• Marcelo Quezado MD 443-801-8889
• Sumanth Kuppalli MD 443-224-3500
  

Block Recipes

• By and large, you will be using 0.5% ropivicaine for everything
  • General volumes (more than you'll be used to):
    • Interscalene: 20 cc
    • Supraclavicular: 20-40 cc (I'm serious)
    • Infraclavicular: 30 cc
    • Adductor/Saphenous: 20 cc
    • Popliteal/Sciatic: 20 cc
  • 21G 100 mm block needle (exception: shorter needle for interscalene)
  • Fent/Versed sedation universally
• For catheters, supplies include:
  • PNC kit
  • Vial(s) of 0.5% Ropivicaine
  • Chloraprep, large/poptart Tegaderm, CHG Tegaderm dressing, sterile ultrasound probe cover (standard for all blocks, whether sterile or not), ultrasound gel, sterile gloves
• If two catheter sites, each pump is run with 0.2% ropivicaine at 10 cc/hour intermittent bolus (PIB) without demand. Otherwise patients with single PNC (e.g. single adductor PNC) have PIB pumps programmed as 8/4/20/3 --> cc per hr / cc demand bolus / lockout interval in minutes / number of demands per hr.

Subsequent Days

• Arrive by 7:00 AM to catch attendings for any first start blocks (in room by 7:30 AM)
• Anticipate bouncing between floors for 1st case starts -> PACU catheters -> preop blocks
• Expect to feel like a medical student until you get to know attendings better
• Josh will often help connect you with attendings doing regional cases in the morning, but you will need to hover frequently
• Some attendings will get better about texting you when there is a block
• APS is a good opportunity for blocks/catheters on the floor. Dr. Jensen (Mark) runs APS service and is very good about keeping you in the loop, and proactive with creating block opportunities
• Fridays start with administrative meeting, thus case starts are at 8:30 AM
• Before going home, peek at the list of cases for the following day to figure out the best OR to show up to and when
  • The anesthesia schedule is published separately and around 3 pm, so you'll likely have to ask someone if you want to know where specific attendings will be

Miscellaneous

• There is a full gym (free weights, machines, cardio) adjacent to the anesthesia offices in the 33rd Street Professional Building
• Nearby cafes for studying if preparing for ITE/Advanced:
  • Bird in Hand (free wifi, outlets for laptop/phone, good food/beverage selection)